Identification of Clostridium difficile Reservoirs in The Patient Environment and Efficacy of Aerial Hydrogen Peroxide Decontamination

Abstract

OBJECTIVE To identify, using a novel enhanced method of recovery, environmental sites where spores of Clostridium difficile persist despite cleaning and hydrogen peroxide aerial decontamination. DESIGN Cohort study. SETTING Tertiary referral center teaching hospital. METHODS In total, 16 sites representing high-frequency contact or difficult-to-clean surfaces in a single-isolation room or bed area in patient bed bays were sampled before and after terminal or hydrogen peroxide disinfection using a sponge swab. In some rooms, individual sites were not present (eg, there were no en-suite rooms in the ICU). Swab contents were homogenized, concentrated by membrane-filtration, and plated onto selective media. Results of C. difficile sampling were used to focus cleaning. RESULTS Over 1 year, 2,529 sites from 146 rooms and 44 bays were sampled. Clostridium difficile was found on 131 of 572 surfaces (22.9%) before terminal cleaning, on 105 of 959 surfaces (10.6%) after terminal cleaning, and on 43 of 967 surfaces (4.4%) after hydrogen peroxide disinfection. Clostridium difficile persisted most frequently on floor corners (97 of 334; 29.0%) after disinfection. Between the first and third quarters, we observed a significant decrease in the number of positive sites (25 of 390 vs 6 of 256). However, no similar change in the number of isolates before terminal cleaning was observed. CONCLUSION Persistence of C. difficile in the clinical environment was widespread. Although feedback of results did not improve the efficacy of manual disinfection, numbers of C. difficile following hydrogen peroxide gradually declined. Infect Control Hosp Epidemiol 2017;38:1487-1492.

Environmental transmission of Clostridioides difficile ribotype 027 at a long-term care facility; an outbreak investigation guided by whole genome sequencing

“…22 A tertiary-care referral center in England sampled 16 different sites within the hospital to guide terminal cleaning with either a sporicidal agent or aerial hydrogen peroxide. Although persistence in the environment was observed, a decrease in the number of positive C. difficile isolates was observed.…”

“…Although uncommon, use of environmental sampling to guide decontamination efforts has been reported 22 . A tertiary-care referral center in England sampled 16 different sites within the hospital to guide terminal cleaning with either a sporicidal agent or aerial hydrogen peroxide.…”

Systematic review on use, cost and clinical efficacy of automated decontamination devices

“…3) [16, 18, 21-31, 34-36, 39-41, 43, 48, 50]. Five (12%) studies were based in the UK, all using hydrogen peroxide, [32,44,53,56,58] and three (7%) others using hydrogen peroxide were performed in France (Fig. 4) [45,46,51].…”

“…There were two studies performed exclusively in burns unit [34,51]; these, along with others, did not indicate the type of host hospital. Other specialist units included intensive care [17,26,32,33,35,39,40,45,46,52,54]; neonatal [58]; biohazard [26] and treatment rooms [51]; bone marrow transplant [16,23,25]; haematology and/or oncology [16,20,25,31]; respiratory therapy room [27]; operating theatres [36,43,48]; dialysis unit [43]; stroke rehabilitation [44]; accident and emergency [48]; and three studies mentioned bathrooms [27] and/or communal areas [26,27,41]. Figure 2 shows the year of publication for each study.…”

“…Some studies reported effects on one or more pathogen rates along with no change or even increases in other pathogen rates. Two studies reported an increase in C.difficile rates using UV and H2O2 [18,32] and another reported static rates for C. difficile and VRE following UV use in a bone marrow transplant unit [23]. One analysis of the BETR study (using UV) saw a reduction only in VRE and not in rates of infection due to C. difficile, MRSA or Acinetobacter, although the latter numbers were so small, the effect could not be analysed [24].…”